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Bill Gates Predicts 'What's At Stake' With Proposed Trump Foreign Aid Cuts

There's at least one thing Bill Gates and President Trump agree on: The media don't always get things right.

For Gates, the problem is with the foreign aid coverage.

"The nature of news is mostly to cover big setbacks," Gates says. "So if a little bit of money was spent improperly, that's what gets the news coverage, even though 99 percent of it was spent well."

This focus on failure leads to false impressions about the effectiveness of foreign aid, says Gates.

"And from time to time — especially when you have an anti-elitist movement — people start questioning whether these investments really have an impact or how much of a priority does it deserve to be," says Gates, whose foundation is a financial supporter of NPR's global health team.

For example, the news rarely mentions that some of the poorest countries, such as Rwanda and Ethiopia, have made dramatic progress in improving the health of their moms and children. Or that in the past three decades, the annual number of deaths of children under age 5 has dropped from about 11 million deaths to fewer than 6 million, Gates says.

"You know those are huge numbers," he says. "For many causes, people talk about saving tens of thousands of lives. Here it's literally millions of children each year."

Now Gates is worried this progress could stall. Or even slide backward.

Earlier this year, Trump called for deep cuts in foreign aid, including a 17 percent reduction in money to treat people with HIV worldwide.

In response, the Bill and Melinda Gates Foundation released a report Wednesday that predicts what could happen if the U.S. — and other countries — scale back foreign aid. A study appears simultaneously in The Lancetjournal explaining how researchers made the predictions.

"We're showing what's at stake," Gates says.

And with HIV, the stakes are high. Even modest cuts to funding could eventually reverse much of the progress made in curbing the epidemic, the analysis finds.

"It would be terrible," says Christopher Murray, the director of the Institute for Health Metrics and Evaluation, who led the analysis for the report. "The effect would be huge."

For the past 25 years, the U.S. has led the effort to treat people with HIV around the world.

"Historically, the U.S. has been a big funder for global health programs in general. About $1 in every $3 is from the U.S.," Murray says. "But for fighting HIV, about half of the money comes from the U.S."

A big chunk of that funding comes from the , or PEPFAR, which George W. Bush launched in 2003. Since then, the U.S. has spent about $8 billion each year fighting HIV worldwide, which works out to about 0.2 percent of the federal budget.

Murray and his team estimated what would happen if total global funding for HIV was cut by 10 percent progressively until 2030. The death rate from HIV could shoot up by more than a third, the analysis predicts. That would mean that an additional 5.6 million people could die over that time period. And the rate of new HIV infections could surge back to what they were during the peak of the epidemic in the late 1990s.

"If things go wrong, even just a little bit, the infections could spread much faster and the epidemic could spiral out of control," says Timothy Hallett, an epidemiologist at Imperial College London, who wasn't involved in the study.

"That's just the nature of infectious diseases," Hallett says. "They can bounce back and rapidly do so."

Congress is still debating what the foreign aid budget will be. And it will likely be different than what Trump put forth. Just this past week, the Senate Appropriations Committee approved a bill that would largely pull back many of Trump's proposed cuts. The bill — which still needs approval from the Senate and House — would cut PEPFAR funding by 6 percent instead of the 17 percent that Trump has called for.

And, of course, there are also uncertainties in the values in the Gates report as well, Hallett says. All these predictions from the Gates Foundation are just that — predictions.

"But I don't think that uncertainty detracts from the point being made," Hallett says. "A retreat from funding would really have a very negative consequence on many health metrics — and peoples' lives."

"Every year that we delay in investing in global health, people are suffering and dying because of that delay," he adds. "That's the simple truth."

Copyright 2020 NPR. To see more, visit https://www.npr.org.

Michaeleen Doucleff, PhD, is a correspondent for NPR's Science Desk. For nearly a decade, she has been reporting for the radio and the web for NPR's global health outlet, Goats and Soda. Doucleff focuses on disease outbreaks, cross-cultural parenting, and women and children's health.